health assessment practice questions

Correct Answer: C

Rationale: The correct answer is C: drooping of the upper eyelid. Ptosis refers to the drooping of the upper eyelid, which may occur due to weakened eyelid muscles or nerve damage. In this case, the nurse suspects ptosis in the 60-year-old man, which is likely due to age-related muscle weakness. Choice A, a cloudy cornea, is incorrect as it refers to a different eye condition. Choice B, an unequal red reflex, is incorrect as it is related to abnormalities in the retina. Choice D, protruding and bulging eyes, is incorrect as it indicates exophthalmos, a condition typically seen in thyroid eye disease.

Correct Answer: D

Rationale: The correct answer is D: trichotillomania, which may be caused by her child habitually twirling her hair in an absent-minded way. Trichotillomania is a psychological disorder where individuals have an irresistible urge to pull out their hair. In this case, the broken-off, stublike hair and irregularly shaped patches on the child's head are indicative of hair pulling rather than a medical condition like folliculitis (choice A), traumatic alopecia (choice B), or tinea capitis (choice C). The child's hair being kept very short does not align with the characteristic of these conditions, making trichotillomania the most likely explanation.

Correct Answer: D

Rationale: The correct answer is D because a normal pupillary light reflex involves the constriction of both pupils in response to bright light. This reflex is controlled by the autonomic nervous system, specifically the parasympathetic nervous system. When light is detected by the retina, signals are sent to the brain which then triggers the constriction of both pupils to reduce the amount of light entering the eye. Choices A, B, and C are incorrect because they do not accurately describe the pupillary light reflex. Vision convergence, light reflection, and focusing the image at the center of the pupil are not directly related to the pupillary light reflex.

Correct Answer: D

Rationale: The correct answer is D. A shattered look to the light rays reflecting off the cornea indicates corneal abrasion. When the cornea is scratched or abraded, light rays reflecting off it appear shattered due to irregularities on the corneal surface. This is a classic sign of corneal abrasion. A: Smooth and clear corneas (incorrect) - This would not indicate corneal abrasion as abrasions cause irregularities on the corneal surface. B: Opacity of the lens behind the cornea (incorrect) - This suggests a different issue related to the lens, not corneal abrasion. C: Bleeding from the areas across the cornea (incorrect) - This suggests a more severe injury like a corneal laceration, not a simple abrasion. In summary, choice D is correct as the shattered look of light rays is a characteristic finding in corneal abrasion, while the other choices do not

Correct Answer: A

Rationale: The correct answer is A because at 7 months, infants typically have developed the ability to localize sounds. When clapping hands, the expected response is for the infant to turn their head towards the sound source, indicating their ability to detect and localize the sound. This behavior reflects the normal auditory development at this age. Choice B is incorrect because by 7 months, infants should show some response to noise, such as turning their head or showing some interest. Choice C is incorrect as the startle and acoustic blink reflex typically occur in response to sudden loud noises, but at 7 months, the infant should also be able to localize the source of the sound. Choice D is incorrect as stopping all movement and appearing to listen is not a typical response expected from a 7-month-old when hearing a sound. Infants at this age are more likely to actively turn towards the sound source to investigate.